The Ratio Between Visceral and Subcutaneous Abdominal Fat Assessed by Computed Tomography Is an Independent Predictor of Mortality and Cardiac Events

Body fat distribution is more predictive of all‐cause mortality than overall adiposity

“…These findings suggest that fat distribution is more important than overall adiposity in determining future mortality. As previously suggested by Ladeiras‐Lopes et al, we propose that VSR, a reliable and reproducible variable for determining fat distribution, may be more important than either SFA or VFA, whose associations with all‐cause mortality have been inconsistent in previous studies …”

“…In this regard, fat indicators measured by CT have been highlighted as a better method to define body fat distribution. Although many previous studies have reported that visceral fat is a strong risk factor of mortality, conflicting results have been reported . Moreover, the effects of subcutaneous fat and the ratio of visceral‐to‐subcutaneous fat on mortality have been controversial among these prior studies .…”

“…Second, we measured fat areas at the level of the umbilicus using a single CT slice. Although the umbilicus is an accepted reference point, many previous studies have used the L4‐L5 intervertebral space as the reference point for its proximity to the level of the iliac crest. Moreover, one recent study has suggested L3 as a better reference point to assess total tissue volumes .…”

“…Although many previous studies have reported that visceral fat is a strong risk factor of mortality, 19,20,22,24 conflicting results have been reported. 21,23,25 Moreover, the effects of subcutaneous fat and the ratio of visceral-to-subcutaneous fat on mortality have been controversial among these prior studies. [19][20][21][22][23][24][25] Using large-scaled cohort data, we determined that fat distribution, as represented by the VSR, was better than overall adiposity in predicting the future risk of all-cause mortality.…”

“…18 Therefore, studies regarding the clinical implications of directly measured body fat are required. Although there have been several studies that have evaluated the relationship between body fat as measured by computed tomography (CT) and mortality, the results were controversial, [19][20][21][22][23][24][25] and most of these studies have highlighted the importance of visceral fat area (VFA), not subcutaneous fat area (SFA) or the visceral-to-subcutaneous fat area ratio (VSR). The aim of this retrospective study was to evaluate the predictive significance of CT-measured body fat, including both VFA and SFA, for mortality in a large health check-up cohort in Korea.…”